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The validity of a sore throat score in family practice

Warren J. McIsaac^*, Vivel Goel, Teresa To^¶ and Donald E. Low^**

From the *Family Medicine Centre, Mount Sinai Hospital, Toronto, Ont.; the Family Health Care Research Unit, Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; the Department of Health Administration, University of Toronto; the Department of Public Health Sciences, University of Toronto; ¶Population Health Sciences, Hospital for Sick Children Research Institute, Toronto, Ont.; the **Department of Microbiology, Mount Sinai Hospital and Toronto Hospital, Toronto, Ont.; and the Department of Laboratory Medicine and Pathobiology, University of Toronto

Background: Reducing the number of antibiotic prescriptions given for common respiratory infections has been recommended as a way to limit bacterial resistance. This study assessed the validity of a previously published clinical score for the management of infections of the upper respiratory tract accompanied by sore throat. The study also examined the potential impact of this clinical score on the prescribing of antibiotics in community-based family practice.

Methods: A total of 97 family physicians in 49 Ontario communities assessed 621 children and adults with a new infection of the upper respiratory tract accompanied by sore throat and recorded their prescribing decisions. A throat swab was obtained for culture. The sensitivity and specificity of the score approach in this population were compared with previously published results for patients seen at an academic family medicine centre. In addition, physicians' prescribing practices and their recommendations for obtaining throat swabs were compared with score-based recommendations.

Results: Of the 621 cases of new upper respiratory tract infection and sore throat, information about prescriptions given was available for only 619; physicians prescribed antibiotics in 173 (27.9%) of these cases. Of the 173 prescriptions, 109 (63.0%) were given to patients with culture-negative results for group A Streptococcus. Using the score to determine management would have reduced prescriptions to culture-negative patients by 63.7% and overall antibiotic prescriptions by 52.3% (both p < 0.01). Culturing of throat samples would have been reduced by 35.8% (p < 0.01). There was no statistically significant difference in the sensitivity or specificity of the score approach between this community-based population (sensitivity 85.0%, specificity 92.1%) and an academic family medicine centre (sensitivity 83.1%, specificity 94.3%).

Interpretation: An explicit clinical score approach to the management of patients presenting with an upper respiratory tract infection and sore throat is valid in community-based family practice and could substantially reduce the unnecessary prescribing of antibiotics for these condition

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